If enacted, HB 7758 would require the Rhode Island auditor general to conduct thorough audits of MCOs to assess whether they are providing better cost-effectiveness, access to services, and health outcomes compared to a state-run fee-for-service Medicaid model. This act may result in significant changes to the management of Medicaid funds, potentially transitioning Rhode Island from a privatized managed care system back to a fee-for-service model based on the audit's findings. The bill mandates that if the audit shows benefits to a state-run model, a transition plan must be developed within two years.
Summary
House Bill 7758 pertains to Medicaid assistance in Rhode Island and aims to enhance the oversight of Managed Care Organizations (MCOs) that administer Medicaid services. The bill reflects concerns about the effectiveness and financial practices of MCOs, as there have been numerous audits indicating that Rhode Island has lacked adequate monitoring. The current system involves the state paying a substantial amount to MCOs for the management of Medicaid benefits, raising concerns about profit margins at the expense of service quality.
Contention
Discussions around HB 7758 indicate a notable divide, with supporters arguing that such audits are necessary to ensure the proper use of taxpayer money and improved healthcare outcomes for Medicaid recipients. However, opponents express concern that moving away from MCOs might disrupt current services and profitability of healthcare providers. The bill addresses the need for MCOs to meet stringent financial accountability standards, which may lead to pushback from these organizations regarding operational changes. Furthermore, the requirement for MCOs to remit excess capitation revenues underscores the ongoing debate over financial transparency in healthcare management.
Sets controls on Medicaid prescription drug costs by imposing transparency and accountability requirements on managed care organizations (MCOs) and their pharmacy benefit managers (PBMs).
Sets controls on Medicaid prescription drug costs by imposing transparency and accountability requirements on managed care organizations (MCOs) and their pharmacy benefit managers (PBMs).
To Amend The Medicaid Fraud Act And The Medicaid Fraud False Claims Act; And To Update Language And Definitions To Reflect Changes Within The Healthcare System;.
Requires Medicaid reimbursement for covered behavioral health services provided by local education agency to student who is eligible Medicaid beneficiary.
Requires Medicaid reimbursement for covered behavioral health services provided by local education agency to student who is eligible Medicaid beneficiary.
Provides for presumptive eligibility for home and community-based services and services provided through program of all-inclusive care for the elderly under Medicaid.